Background and Objectives: Postoperative pain and stress elicit hormonal changes. We aimed at comparing the effects of wound infiltration with ketamine versus dexmedetomidine on postoperative pain and stress response. Methods: This double-blinded study included ninety patients scheduled for total abdominal hysterectomy and were randomly assigned into three groups to receive local wound infiltration with 40 mL of 0.25% bupivacaine (group C), plus 2 mg/kg ketamine (group K) or 2 lg/kg dexmedetomidine (group D). Primary outcome was postoperative morphine consumption; secondary outcomes included first request of analgesia, VAS scores at rest and movement (VAS–R/M) and side effects. Serum cortisol, prolactin and glucose levels at baseline, pre-infiltration, 6 and 24 h postoperatively were measured. Results: Rescue analgesia was less in K (6.80
3.19 mg) and D (8.39
3.86 mg) compared to C (13.33
4.01 mg) (p 0.05). First request of analgesia was delayed in K (7.60
4.16 h) and D (6.00
3.73 h) compared to C (4.20
1.13 h) (p 0.05). Both VAS and R/M were significantly lower in K (all over 24 h) and D (for 8 and 4 h, respectively) compared to C. Stress markers were significantly lower in K and D compared to C at 6 and 24 h, and in K compared to D at 24 h (p 0.05). Conclusions: Local wound infiltration with ketamine or dexmedetomidine added to bupivacaine had an opioid-sparing effect, delayed first request of rescue analgesia, and attenuated postoperative stress response, especially with ketamine in patients underwent total abdominal hysterectomy.

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Background: The ECF (Epirubcin/Cisplatin/5-fluorouracil) as first line therapy in metastatic gastric is the optimal therapeutic option but its complexity limits its utility in many communities. Methods: We investigated a more convenient modification of the standard approach, "5 days CIV 5-fluorouracil 1000mg/m2". A total of 115 patients with advanced and metastatic adenocarcinoma of the stomach and gastroesophageal cancer were reviewed retrospectively to compare the efficacy of modified ECF with the reference protocols FAM and ELF Results the number of patients in each regimen was 41 patients received modified ECF while 42 received ELF and 32 received FAM. The overall response rate was 36.5% with ECF, 16.6% with ELF, and 15.6% with FAM, with significant differences p=0.001. No one achieved a complete tumor remission. However, 4 patients with locally advanced stomach were able to have total gastrectomy in ECF arm only with p=0.000. Hematologic toxicities were more common in ECF p= 0.01. On the other hand, there was no significant difference in progression free survival or overall survival between the three regimens. Conclusion Modified ECF showed significant overall response than FAM and FLF. However survival benefit is very small. So we recommend using this regimen as neoadjuvant treatment.

Background: The ECF (Epirubcin/Cisplatin/5-fluorouracil) as first line therapy in metastatic gastric is the optimal therapeutic option but its complexity limits its utility in many communities. Methods: We investigated a more convenient modification of the standard approach, "5 days CIV 5-fluorouracil 1000mg/m2". A total of 115 patients with advanced and metastatic adenocarcinoma of the stomach and gastroesophageal cancer were reviewed retrospectively to compare the efficacy of modified ECF with the reference protocols FAM and ELF Results the number of patients in each regimen was 41 patients received modified ECF while 42 received ELF and 32 received FAM. The overall response rate was 36.5% with ECF, 16.6% with ELF, and 15.6% with FAM, with significant differences p=0.001. No one achieved a complete tumor remission. However, 4 patients with locally advanced stomach were able to have total gastrectomy in ECF arm only with p=0.000. Hematologic toxicities were more common in ECF p= 0.01. On the other hand, there was no significant difference in progression free survival or overall survival between the three regimens. Conclusion Modified ECF showed significant overall response than FAM and FLF. However survival benefit is very small. So we recommend using this regimen as neoadjuvant treatment.